Autoimmune hepatitis

Question 1

Epidemiology of autoimmune hepatitis

Answer 1

Usually seen in young and middle-aged women

it is commonly associated with other autoimmune disorders

Question 2

Clinical features of autoimmune hep

Answer 2

Jaundice
fatigue
Loss of appetite
Hepatomegaly
Splenomegaly
Abdo pain

Question 3

LFT results

Answer 3

Liver function tests are usually deranged and indicate a hepatic pattern of disease such as Raised ALT and bilirubin with normal/mildly raised ALP.

Patients may have an IgG predominant hypergammaglobulinemia.

Question 4

There are three main types of autoimmune hepatitis including:

Answer 4

Type 1 - The commonest type. These patients have raised levels of anti-smooth muscle antibodies (80%), and antinuclear antibodies may also be positive (10%).

Type II - Less common but often more severe; anti liver/kidney microsomal antibodies type 1 tend to be positive.

Type III - Also less common, and often positive for anti-soluble liver antigen.

Type II and III AIH are negative for anti-smooth muscle antibodies and antinuclear antibodies.

Question 5

Management of AIH

Answer 5

Treatment is dependent on severity of symptoms and severity of disease based on blood results and liver biopsy.

Steroid (prednisolone) induction therapy followed by maintenance therapy with azathioprine, which is effective in most cases.

For patients who do not respond to standard treatment, second-line treatment with other immunosuppressants can be effective.